title: Intraoperative blood loss independently predicts survival and recurrence after resection of colorectal cancer liver metastasis.
abstract: BACKGROUND
  Although numerous prognostic factors have been reported for colorectal cancer liver metastasis (CRLM), few studies have reported intraoperative blood loss (IBL) effects on clinical outcome after CRLM resection.
  
  
  METHODS
  We retrospectively evaluated the clinical and histopathological characteristics of 139 patients who underwent liver resection for CRLM. The IBL cutoff volume was calculated using receiver operating characteristic curves. Overall survival (OS) and recurrence free survival (RFS) were assessed using the Kaplan-Meier and Cox regression methods.
  
  
  RESULTS
  All patients underwent curative resection. The median follow up period was 25.0 months (range, 2.1-88.8). Body mass index (BMI) and CRLM number and tumor size were associated with increased IBL. BMI (P=0.01; 95% CI = 1.3-8.5) and IBL (P<0.01; 95% CI = 1.6-12.5) were independent OSOs predictors. Five factors, including IBL (P=0.02; 95% CI = 1.1-4.1), were significantly related to RFS via multivariate Cox regression analysis. In addition, OSOs and RFS significantly decreased with increasing IBL volumes. The 5-year OSOs of patients with IBL≤250, 250-500, and >500mL were 71%, 33%, and 0%, respectively (P<0.01). RFS of patients within three IBL volumes at the end of the first year were 67%, 38%, and 18%, respectively (P<0.01).
  
  
  CONCLUSIONS
  IBL during CRLM resection is an independent predictor of long term survival and tumor recurrence, and its prognostic value was confirmed by a dose-response relationship.
authors.affiliation: Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China ; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Wu
authors.initials: W
authors.lastname: Jiang
authors.forename: Yu-Jing
authors.initials: YJ
authors.lastname: Fang
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Wu
authors.forename: Fu-Long
authors.initials: FL
authors.lastname: Wang
authors.forename: Zhen-Hai
authors.initials: ZH
authors.lastname: Lu
authors.forename: Rong-Xin
authors.initials: RX
authors.lastname: Zhang
authors.forename: Pei-Rong
authors.initials: PR
authors.lastname: Ding
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Fan
authors.forename: Zhi-Zhong
authors.initials: ZZ
authors.lastname: Pan
authors.lastname: De-Sen Wan
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001810:Blood Volume; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome